А. Ю. Буланов
Гематологический научный центр РАМН, Москва

Информация для контакта:
Буланов Андрей Юрьевич.
E-mail: buldog68@mail.ru

Острое трансфузионное поражение легких (TRALI) — это острое повреждение легких, связанное с трансфузией компонентов и препаратов крови, развивающееся в течение 6 ч после нее. На сегодняшний день единых представлений о патогенезе TRALI нет. Правомерно обсуждение иммунного и неиммуного механизмов. Ключевым звеном первого является наличие у донора или реципиента антилейкоцитарных антител и взаимодействие их при трансфузии с лейкоцитами реципиента или донора соответственно, второго — накопление в трансфузионных средах в процессе хранения биологически активных субстанций и пассивное введение их при трансфузии в организм реципиента. Итоговое звено в обоих случаях — резкое повышение проницаемости легочных капилляров. Клиника TRALI неспецифична, как правило, сходна с клиникой РДСВ и поражений легких другого генеза. Дифференциальную диагностику следует проводить с аллергическими реакциями, трансфузией бактериально-контаминированных сред и главным образом с циркуляторной перегрузкой. Специфических методов лечения трансфузионного поражения легких не существует. Эффективны различные варианты респираторной терапии. Важную роль играет профилактика TRALI, основанная главным образом на иммунном механизме патогенеза. Ведущим направлением ее является отбор доноров.

Ключевые слова:  трансфузионная терапия, осложнения, острое легочное повреждение.

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